Search Results (48)

Hyperketonemia (HYK) is a common disorder in high-producing dairy cows, resulting in significant economic losses. Defined by elevated beta-hydroxybutyrate (BHB; ≥1.2 mmol/L) without clinical signs, HYK is often considered a gateway disease, predisposing cows to other metabolic and infectious problems. Our objective was to investigate the association between previous lactation risk factors and both BHB concentration and HYK status during the first week postpartum in the subsequent lactation. A retrospective study was conducted using previously collected blood samples from 2336 Holstein multiparous dairy cows from 7 dairy herds, where BHB concentration was measured during the first week postpartum. Data from the previous lactation were extracted from electronic farm records. Log-transformed BHB concentrations and HYK status were each modeled using separate linear mixed models. Both models included the same set of risk factors—lactation, previous lactation total times bred, dry length period, previous lactation days in milk, previous lactation days open, previous lactation days carried calf, previous lactation peak milk production, previous lactation total milk production, previous lactation total milk fat, and previous lactation total milk protein—to investigate their association with these outcomes. Potential confounding variables were offered to the models, and stepwise backward elimination was used to determine which covariates to retain. Significant associations were detected between BHB concentration and dry period length (DDRY), lactation number (LACT), previous lactation total milk protein (TOTP), and previous lactation days open (PDOPN). Inclusive, significant associations were detected between HYK status and previous lactation total milk production (PTOTM), DDRY, LACT, TOTP, and PDOPN. Our results suggest that a dry period longer than 60 days, days open exceeding 130 days, being in their third or greater lactation, and each additional 1000 kg of milk produced in the previous lactation are associated with an increased risk of having high BHB and HYK in the first week postpartum in the subsequent lactation. Full article

Objective: This study examines early neonatal adaptation and birth complications in adolescents with term pregnancies who had positive cervical canal cultures upon hospital admission. Methods: This retrospective study analyzed data from 1 January 2015 to 15 November 2024. Conducted at Bonifraters Medical Center in Katowice, Poland, the study included 267 individuals, with 178 over the age of 19 and 89 under the age of 19. Results: Adolescents exhibited significantly higher rates of positive GBS cultures in the third trimester (62.92% vs. 38.20%; p < 0.001) than older individuals. Neonates of adolescent mothers experienced increased congenital pneumonia (7.87% vs. 1.12%; p = 0.012) and antibiotic administration (10.11% vs. 2.81%; p = 0.026). Lactation failure was markedly higher in adolescent mothers (10.11% vs. 1.12%; p = 0.002). Adolescents also showed more postpartum blood loss (median: 250 mL vs. 200 mL; p < 0.001) and more extended hospital stays (median: 3 vs. 2 days; p = 0.002). Neonatal anthropometric measures revealed shorter body lengths in the adolescent group (median: 53 cm vs. 54 cm; p = 0.003). Conclusions: Adolescent pregnancies are associated with significantly higher rates of complications and adverse neonatal outcomes, especially infectious causes. Although our study results are preliminary, it appears that chronic GBS colonization in pregnant adolescents may impact pregnancy and newborn outcomes. Full article

Objective: This study aimed to analyze and compare three different methods of estimated blood loss (EBL) assessment in conjunction with the exploration of risk factors associated with early postpartum hemorrhage (PPH) among women undergoing a cesarean section (CS). Methods: Women with a singleton pregnancy who underwent an elective/emergency CS were recruited for this prospective cross-sectional study. Early PPH was defined as a cumulative blood loss ≥1000 mL within the 24 h period following the delivery. Methods of EBL assessment included the following: (1) visual estimation by the surgeon (sEBL), (2) the evaluation of blood-soaked dressings (dEBL), and (3) implementation of a mathematical formula (fEBL). Results: In the study period, 21 cases of early PPH were identified and compared with 452 controls. Among the patients with a PPH, a significant increase in the surgery time (60 min. vs. 46 min., p = 0.001), fetal birthweight (3780 g vs. 3417.5 g, p < 0.01), the occurrence of uterine atony (61.9% vs. 2.2%, p < 0.001), and myomas (9.5% vs. 1.1%, p < 0.05) was noted. In both groups, dEBL and sEBL provided the highest and the lowest EBL values, respectively (PPH dEBL: 1230 mL vs. fEBL: 1173.3 mL vs. sEBL 1000 mL, p < 0.001; control dEBL: 652 mL vs. fEBL 604 mL vs. sEBL 600 mL, p < 0.001). A patient age of 31–34 years (OR 1.71; 95%CI: 1.19–2.44), overweight (OR 2.65; 95%CI: 1.87–3.76), obesity (OR 2.68; 95%CI: 1.71–4.21), emergency mode of CS (OR 4.06; 95%CI: 2.94–5.62), surgeon experience (resident OR 1.86; 95%CI: 1.27–2.7; assistant specialist OR 3.13; 95%CI: 2.15–4.55) and fetal macrosomia (OR 3.19; 95%CI: 2.14–4.74) were selected as significant risk factors of the PPH. Conclusions: In women with early PPH following a CS, both dEBL and fEBL provide comparable estimations of blood loss. An emergency-mode CS and fetal macrosomia are the strongest contributors to PPH among women undergoing a CS. A combination of different methods of EBL with the proper identification of risk factors of a PPH can lead to improvement in the clinical management of obstetric hemorrhage following the CS. Full article

Background/Objectives: Maternal mortality occurs at alarming rates in the United States. In 2018, there were 17 maternal deaths for every 100,000 births—double that of other high-income countries, including France and Canada. Postpartum hemorrhage (i.e., excessive blood loss during delivery or within the 24 h following) is a leading cause of maternal mortality and is a treatable condition if identified and managed in a timely manner. One aspect of work that impacts patient care during postpartum hemorrhage is the safety culture. The safety culture is the beliefs, values, and norms shared by members of the organization that influence their actions and behaviors. In this study, we use the Systems Engineering Initiative for Patient Safety (SEIPS) model to understand and describe how the sociotechnical system shapes safety culture during postpartum hemorrhage. Methods: We conducted interviews and focus groups with 29 clinicians to describe the work system and the barriers and facilitators during postpartum hemorrhage. Then, we inductively categorized the barriers and facilitators into emergent properties of sociotechnical systems related to safety culture. Results: We identified 45 barriers and 158 facilitators into five emergent properties related to the safety culture (i.e., staffing, communication, organizational management and leadership, organizational processes, and teamwork). The participants identified more positive aspects than negative, suggesting that the safety culture positively influences their actions and behaviors. Conclusions: Our results indicate that safety culture could be improved by redesigning the work system to mitigate barriers related to staffing, communication, organizational management, and teamwork that hinder the safety culture. Full article

This study presents findings from two discrete experimental processes that examined the impact of lameness events on two consecutive, critical time points in the annual production cycle of dairy cattle (early in puerperium—first study, and later at the onset of the reproductive period—second study) regarding liver function, glucose levels, milk production, body condition score, and back fat thickness. In the first study, 47 cows (lame group n = 22, control group n = 25) were monitored from 10 days ante partum (ap) to 46 days post-partum (pp). In the second study, 79 cows (lame group n = 52, control group n = 27) were monitored from day 28 ± 5 pp to day 65–72 ± 5 pp. Lame cows had greater gamma-glutamyl transferase (GGT) concentrations in the blood serum compared to control cows (25.83 vs. 23.56, p = 0.02, respectively) early in puerperium, whereas the two groups did not differ in the second study. The concentration of glutamate dehydrogenase (GLDH) was lower for lame compared to control cows in both studies (17.24 vs. 24.60, respectively, p = 0.02 in the first study, and 30.50 vs. 51.10, respectively, p = 0.02 in the second study). The concentrations of aspartate transaminase (AST) and glucose did not differ between groups in both studies. Lame cows had a lower body condition score (BCS) and backfat thickness (BFT) scores compared to the control in both studies overall. The lame cows of the first study experienced a significant loss of milk production, especially during the second month of lactation, while in the second study, milk production remained unaffected. Conclusively, lame cows have lower BCS and BFT values, whereas milk yield can be negatively affected only if lameness occurs early in the puerperium, probably beginning at the dry period. However, the current research shows that acutely lame cows, as described in this study, exhibit only mild alterations in liver function compared to non-lame ones. Full article

The plasma protein fibrinogen is critical for haemostasis and wound healing, serving as the structural foundation of the blood clot. Through a complex interaction between coagulation factors, the soluble plasma fibrinogen is converted to insoluble fibrin networks, which form the skeleton of the blood clot, an essential step to limit blood loss after vascular trauma. This review examines the molecular mechanisms by which fibrinogen modulates bleeding, focusing on its interactions with other proteins that maintain fibrin network stability and prevent premature breakdown. Moreover, we also cover the role of fibrinogen in ensuring clot stability through the physiological interaction with platelets. We address the therapeutic applications of fibrinogen across various clinical contexts, including trauma-induced coagulopathy, postpartum haemorrhage, and cardiac surgery. Importantly, a full understanding of protein function will allow the development of new therapeutics to limit blood loss following vascular trauma, which remains a key cause of mortality worldwide. While current management strategies help with blood loss following vascular injury, they are far from perfect and future research should prioritise refining fibrinogen replacement strategies and developing novel agents to stabilise the fibrin network. Exploiting fibrinogen’s molecular properties holds significant potential for improving outcomes in trauma care, surgical interventions and obstetric haemorrhage. Full article

Background/Objectives: Previous literature has described that non-white pregnant patients are at increased risk of severe morbidity from obstetric hemorrhage (OBH). Here, we investigate whether such disparities are secondary to delay in the administration of postpartum oxytocin for non-white patients compared to white patients. Methods: This is a retrospective cohort study of all deliveries from 2018 to 2019, comparing (1) Hispanic white or non-white race (HW/NWR) pregnant people and (2) non-Hispanic white (NHW) pregnant people. Our primary outcome was the time from delivery to the first dose of postpartum oxytocin, and our secondary outcome was the frequency of other hemorrhage interventions. Results: Out of 3832 patients with self-identified race and ethnicity recorded in their patient record, 644 patients identified as NHW, and 3188 patients identified as HW/NWR. We found no difference in time to first dose of postpartum oxytocin (p = 0.51), and there was also no difference in the frequency of other hemorrhage-related interventions. Conclusions: Our study found no delay in the administration of postpartum oxytocin for non-white patients. Full article

Background: Obstetric hemorrhage is the leading cause of maternal death worldwide. Obstetric hemorrhage accounts for 27.1% of all maternal death worldwide. Of all obstetric hemorrhages, postpartum hemorrhage (PPH) accounts for 72%. The physiological management of the third stage of labor is a growing area as a preventive measure to control postpartum blood loss. Immediate kangaroo mother care (KMC) is suggested as one of the physiological management methods of the third stage of labor to reduce postpartum blood loss. The duration of the third stage of labor, uterine involution, and amount of postpartum blood loss are the physiological parameters of effective management of the third stage of labor. Examining the absolute effects of immediate KMC on maternal physiological parameters is needed in different populations with different settings. Thus, this study aimed to examine the effects of immediate KMC on uterine involution and postpartum blood loss. Methods: A quasi-experimental comparative design was conducted in the labor and delivery room at Maternity and Children Hospital, Makkah, Saudi Arabia. A sample of 80 women was divided into two equal groups: a treatment group that underwent immediate KMC and a control group that received routine care. Instrument: A questionnaire developed by the researchers was used to collect the data. Results: The effects of immediate KMC were significant concerning uterine involution and regarding the uterine position immediately after placenta separation (70% at umbilicus, χ² = 8.5, p < 0.01), postpartum blood loss (χ² = 76.098, p < 0.00), the heaviness of lochia (χ² = 44.679, p = 0.00), and the number of pads used in the first 24 h (p < 0.001). Full article

This study investigated the prevalence and severity of lameness in dairy cow herds, focusing on its relationship with milk traits, metabolic profile, and dry period management. Lameness was evaluated in 4221 multiparous Holstein dairy cows during early lactation (up to 60 days postpartum) using a 1-to-5 scale. The average lameness score was 1.67, with a prevalence of 10.66% (scores 3 to 5) and 4.55% classified as severe (scores 4 to 5). Severe lameness was associated with energy-corrected milk losses of −11.00 kg/day (p < 0.001) and a decrease in milk lactose concentration by −0.16 percentage points (p < 0.001), alongside a rise in somatic cell scores by +0.11. The incidence of cows with a milk fat-to-protein ratio below 1.2 increased by 21.7 percentage points, while those with a ratio above 1.4 rose by 19.1 percentage points as lameness worsened. Additionally, non-esterified fatty acid concentrations increased by 1.46 times as lameness severity intensified (p < 0.001). Cows without lameness had blood cortisol levels 1.86 times lower than affected cows, with cortisol tripling in those with the highest scores. A dry period of 30 to 60 days was correlated with more healthy cows, whereas periods over 90 days resulted in 1.586 times higher odds of lameness (p < 0.05). This research underscores the need for improved management strategies to enhance dairy cow welfare and productivity. Full article

Background: Deranged antepartum laboratory parameters may be risk factors for postpartum hemorrhage (PPH). However, whether this is also valid in women who give birth prematurely is currently unknown. Methods: We performed a retrospective single-center study to assess the role of antepartum hemoglobin, platelet count, fibrinogen, activated partial thromboplastin time, and prothrombin time as risk factors for PPH following caesarean section. We defined PPH as documented blood loss of at least 1 L and/or transfusion of red blood cell concentrates. We stratified the included patients according to gestational age: extremely preterm (gestational age < 28 weeks), very preterm (gestational age between 28 and 32 weeks), late and moderate preterm (gestational age between 32 and 37 weeks), and term (gestational age ≥ 37 weeks). Results: We included 1734 patients, 112 (6%) of whom had PPH. In total, 19 patients (10%) were in the extremely preterm group, 13 patients (10%) were in the very preterm group, 44 patients (9%) were in the late and moderate preterm group, and 36 patients (4%) were in the term group. Hemoglobin predicted PPH in all gestational age groups. Platelet count was associated with PPH in term, but not in preterm patients. Fibrinogen was associated with PPH in late prematurity but not in term patients and not in patients with early or extreme prematurity. Conclusions: Antepartum hemoglobin was the only factor predicting PPH in preterm and term caesarean sections. Platelet count and fibrinogen concentration were associated with PPH in term and late prematurity, respectively, but not in earlier stages of prematurity. Full article

Background: Adolescent pregnancy is associated with increased risk of both maternal and neonatal complications. Common maternal complications include anemia, hypertensive disorders, and a higher incidence of infections, including Group B Streptococcus (GBS). Additionally, adolescents are at increased risk for gestational diabetes and postpartum hemorrhage. Neonatal complications often involve low birth weight, prematurity, and an increased likelihood of neonatal intensive care unit (NICU) admission. Objectives: This study aims to assess and compare the prevalence of obstetric complications between adolescent and older pregnant women. Methods: This retrospective study investigates obstetric outcomes in adolescent pregnancies, analyzing data collected from 1 January 2016 to 30 June 2024. This study included 902 participants, of whom 224 were adolescents. The variables were categorized into maternal, birth, and neonatal characteristics. Results: Adolescent patients demonstrated a significantly higher prevalence of Group B Streptococcus (GBS) infection, affecting 25.89% of this group. Adolescent patients reported 17.86% nicotine use during pregnancy, a rate significantly higher than that of older age groups (p < 0.001). Additionally, adolescent pregnancies were associated with the highest mean blood loss during delivery, averaging 500 mL during vaginal birth and 1050 mL during cesarean section, leading to a higher incidence of blood transfusions (3.13%, p = 0.021). Newborns from adolescent pregnancies had the lowest mean birth weight (3199 g) and length (53.6 cm). Neonatal complications were more frequent in this group, affecting 20.09% of newborns, with a significantly higher rate of admission to intensive care units (2.68%, p = 0.008). These findings underscore the need for targeted interventions and more proactive management strategies to address the specific challenges faced by this population. Full article

Background: Gestational diabetes mellitus (GDM) is the main cause of hyperglycemia in pregnancy and is related to complications throughout the gestational and post-partum period. Objectives: To analyze the pregnancy outcomes related to the occurrence of GDM in women and their offspring. Methods: Third-trimester pregnant women were interviewed and monitored until childbirth. The diagnosis of GDM, blood glucose ≥ 92 mg/dL, was defined by the criteria of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Results: A total of 138 women participated, and there were 136 births (due to 2 fetal losses); 23 (16.7%) were diagnosed with GDM. The risk of complications during childbirth was higher among pregnant women with GDM (RR 3.40; 95%CI 1.65–7.00), as was the occurrence of cesarean birth (RR 1.9; 95%CI 1.46–2.59). The occurrence of preterm birth did not show a significant difference between GDM/non-GDM groups. There was a non-significant association in adjusted analyses of macrosomia (birth weight ≥ 4000 g) among newborns born to mothers with GDM (RR 1.27; 95%CI 0.67–2.38). For newborns born to pregnant women with GDM, there was a higher risk for the following outcomes: large for gestational age (LGA) (3.29 95%CI 1.62–6.64), low Apgar (4.98 95%CI 2.32–10.69), and birth asphyxia (9.51 95%CI 3.42–26.48). Conclusions: The findings reinforce that GDM is an important risk factor for adverse pregnancy outcomes for women and their offspring. Full article

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Routine treatment of PPH includes uterotonics, tranexamic acid, curettage, uterine (balloon) tamponade, compression sutures, uterine artery ligation, and, if available, transcatheter arterial embolization (TAE). In cases of severe PPH refractory to standard medical and surgical management, hysterectomy is usually the ultima ratio, and is equally associated with a higher rate of complications. In addition, this sudden loss of fertility, especially in young women, can be devastating. Here, we report a case of a 29-year-old woman who suffered from severe PPH with a blood loss > 1500 mL and hemodynamic instability after delivery of her first baby at a smaller hospital. She was consequently successfully treated with resuscitative endovascular balloon occlusion of the aorta (REBOA) by first placing a balloon catheter into the infra-renal aorta and subsequent TAE after failure of all other available treatment options prior to hysterectomy. TAE has been suggested in PPH treatment to avoid hysterectomies and thus to preserve patients’ reproductive function. If hemodynamic stabilization cannot be achieved with mass transfusion, REBOA seems to be an effective rescue strategy with which to achieve hemodynamic stabilization and gain additional time for embolization. Although REBOA is already recommended in several PPH guidelines, this approach seems relatively unknown in German-speaking countries. Full article

We previously reported that a combined myo-inositol, probiotics, and enriched micronutrient supplement (intervention) taken preconception and in pregnancy reduced postpartum blood loss (PBL) and major postpartum hemorrhage compared with a standard micronutrient supplement (control), as secondary outcomes of the NiPPeR trial. This study aimed to identify the intervention components that may contribute to this effect. Associations of plasma concentrations of myo-inositol and vitamins B2, B6, B12, and D at preconception (before and after supplementation), early (~7-weeks), and late pregnancy (~28-weeks) with PBL were assessed by multiple linear regression, adjusting for site, ethnicity, preconception BMI, parity, and previous cesarean section. Amongst 583 women, a higher concentration of myo-inositol in early pregnancy was associated with a PBL reduction [β_adj −1.26 (95%CI −2.23, −0.29) mL per µmol/L myo-inositol increase, p = 0.011]. Applying this co-efficient to the increase in mean 7-week-myo-inositol concentration of 23.4 µmol/L with the intervention equated to a PBL reduction of 29.5 mL (~8.4% of mean PBL of 350 mL among controls), accounting for 84.3% of the previously reported intervention effect of 35 mL. None of the examined vitamins were associated with PBL. Therefore, myo-inositol may be a key intervention component mediating the PBL reduction. Further work is required to determine the mechanisms involved. Full article

This study evaluated a commercial pregnancy-associated glycoproteins (PAGs)-based pregnancy test using whole blood or plasma samples during early pregnancy (28–55 days of gestation) in high-producing dairy cows. Transrectal ultrasonography was used as the gold standard method. The study population constituted of 284 cows. False positive diagnoses were recorded from Day 60 to 89 and from Day 60 to 99 postpartum in blood and plasma samples, respectively. In early pregnancy screening, correct positive diagnoses were recorded in 75% and 100% of blood and plasma samples, respectively. High milk production was associated with negative results in blood samples and with the lowest test line intensity in plasma samples. False positive or negative diagnoses were recorded in 0% of both types of samples in cows previously diagnosed as pregnant and showing signs of estrus. In conclusion, the use of plasma was more effective than the use of blood in early pregnancy diagnosis. In cows previously diagnosed as pregnant and showing signs of estrus, both types of samples showed the same results. Because of large individual variations, normal single pregnancies could not be differentiated from twin pregnancies, from pregnancies with a recently dead conceptus, or from pregnancies that experienced subsequent pregnancy loss. Full article